Optimizing Shivering Prophylaxis in Obstetrics: Defining the Efficacious Low-Dose Threshold for Intravenous Dexamethasone
-
Milad Masaeli
,
Mohammadreza Habibzadeh
,
Setayesh Sindarreh
,
Kazhal Mirzaee Tabar
,
Zahra Safari
,
Tayyebe Faraji
Abstract
Background: Post spinal anesthesia shivering (PSAS) remains a common and distressing complication during cesarean delivery, with potential metabolic and cardiovascular consequences for parturients. Although several pharmacological strategies have been proposed for its prevention, the optimal prophylactic regimen with minimal adverse effects is still under investigation.
This study aimed to evaluate the effectiveness of dexamethasone, alone or in combination with meperidine, in preventing post spinal anesthesia shivering in patients undergoing cesarean section.
Methods: In this randomized double-blind trial, 144 parturients undergoing cesarean section under spinal anesthesia were assigned to receive intravenous dexamethasone 4 mg (n=50), dexamethasone 6 mg (n=43), or saline placebo (n=51). Shivering was graded on a validated four-point scale. The primary outcome was shivering intensity, while shivering incidence, hemodynamic parameters, adverse events, pethidine requirements, and patient satisfaction were considered secondary outcomes. Sample size was calculated based on a prior effect size with a power of 80% and a significance level of 0.05.
Results: Shivering incidence was 70% in the dexamethasone 4 mg group, 53.5% in the 6 mg group, and 49% in controls (DEXA-4 vs control: OR=2.41, 95% CI: 1.10–5.31; DEXA-6 vs control: OR=1.20, 95% CI: 0.55–2.63) (p=0.083). Shivering intensity was significantly lower in both dexamethasone groups compared with the control (p=0.001). Time to shivering onset and need for pethidine were also reduced in the dexamethasone groups (p=0.010 and p=0.017, respectively). Hemodynamic profiles and adverse event rates did not differ significantly among groups.
Conclusion: The findings suggest that dexamethasone, particularly when used as an adjunct to low dose meperidine, may provide effective prophylaxis against PSAS while potentially reducing opioid related side effects. This approach represents a practical and well tolerated strategy for shivering prevention during cesarean delivery under spinal anesthesia.
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| Keywords | ||
| Dexamethasone Shivering Spinal anaesthesia Cesarean section Postanaesthetic shivering. | ||
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